A media analysis approach to evaluating national health information infrastructure development

DOIhttps://doi.org/10.1108/13287260910983605
Pages208-229
Published date14 August 2009
Date14 August 2009
AuthorSophie Cockcroft
Subject MatterInformation & knowledge management
JSIT
11,3
208
Journal of Systems and Information
Technology
Vol. 11 No. 3, 2009
pp. 208-229
#Emerald Group Publishing Limited
1328-7265
DOI 10.1108/13287260910983605
A media analysis approach to
evaluating national health
information infrastructure
development
Sophie Cockcroft
Business School, University of Queensland, St Lucia, Australia
Abstract
Purpose – The purpose of this paper is to evaluate electronic health record (EHR) initiatives at the
national/external level. Governments are investing large amounts of money in national EHR systems.
These systems are socially and politically complex and a variety of stakeholders (e.g. at the
individual, organisational or national level) have an interest in evaluating such systems from
technical, economic or patient outcome perspectives. In cognisance of academic research in the area,
this paper presents an approach which uses the perspective of one particular type of professional
critic, the media, to identify issues and evaluate their impact at a national level.
Design/methodology/approach – The work is conducted using an established evaluation
framework and formal content analysis of selected relevant articles from the quality press of three
selected countries.
Findings – Different issues take prominence in centralised vs decentralised EHR approaches. In
countries with a decentralised approach issues of standards and interoperability take the fore. Where
there is a more centralised approach the media focus is mo re on project management, budgetary and
financial aspects. In all coverage political and economic aspects are emphasised over technical or
patient outcome issues.
Originality/value – The paper represents the application of the content-context-process framework.
It contributes to the information systems evaluation literature at the national/exter nal level.
Keywords Health services, Records management, Mass media, Australia, Canada, United Kingdom
Paper type Research paper
1. Introduction
Integrated health information systems (ISs) provide unprecedented oppo rtunities for
patient-centred health information management. Ideally such systems afford the
citizen, and their healthcare providers (HCPs), many benefits; better continuity of care
and treatment in emergencies, empowerment in managing their own health
information, targeted advice and monitoring, and the ability to consent, or otherwise,
for their data to be used for various pu rposes (Manning, 2005). Implementing such
systems on anational or international scale presents significant c hallenges and
requires organizational change. How these challenges are portrayed in the media has a
profound influence on public opinion.
In the past decade the collection, storage and use of individual health and medical
data have become increasingly computerised, with the result that it can be collated,
stored, analysed and distributed in unprecedented quantities and put to diverse uses.
Many of these uses have undeniable benefits, but some have aroused concern about
privacy and security of personal information. The governments of industrialised
nations worldwide, however, are seeking to develop centralised lifelong online health
records for their citizens. Proposed benefits of centralised online electronic health
records (EHRs) include: improved clinical decision making, reduced duplication of
diagnostic testing, better medication management, and increasing adoption of
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National health
information
infrastructure
209
screening programmes. Doctors and HCPs have a coordinated means to share clinical
data and to support shared care. At a government level the type of benefits cited are
better informed policy development, improved resource allocation, identification of the
causes and risk factors in disease, and more data for epidemiological research and
disease tracking (Carter, 2000).
The key players in any integrated health infrastructure initiative are the relevant
government offices and politicians, HCP,professional institu tes, patient representatives
and professional critics including audit bodies and academia (Sauer and Willcocks,
2007). The press is a unique form of professional critic, since it has the power to frame
issues and sway public opinion. In order for all the players to present their positions on
critical issues, it is necessary for them to understand the media landscape. The news
media are charged with covering issues in a balanced and informative manner. These
issues are framed for the public by newspapers using particular language and
opinions, which in turn feedback the weight of pub licopinion to policy makers.
This study examines three major integrated health system initiatives in Canada, the
UK and Australia. It reviews how these systems are framed in the major newspapers of
the countries concerned. The aim of the current project is to explore the media’s role in
public perception of integrated health records (IHR) and provide evidence or otherwise
of coverage of the issues that researchers deem critical. It is proposed that this evidence
is analogous to an external evaluation. This is done via a forma l content analysis.
The success or otherwise of large ISs projects is notoriously hard to measure. In
health ISs evaluation evidence is emerging of a shifting emphasis toward quality of
patient care as a desired outcome as opposed to more technical or laboratory based
evaluation studies (Ammenwerth and de Keizer, 2005) and qualitative methods (Hendy
et al., 2005). In the field of health ISs, there has been a dominance of the randomised
control trial (RCT) as an evaluation method. The RCT is the established method for
testing new drugs, and has often been applied to health ISs, to some criticism from
health informatics practitioners (Kaplan, 2001; Wyatt and Wyatt, 2003; Kaplan and
Shaw, 2004). Patient outcomes are nonetheless a proxy for system success. These RCT
style studies are by necessity situated at the organisational or internal level. When
evaluating systems at the national or external level it also must be acknow ledged that,
when a large project is carried out in the health domain, what is represented by the
resultant IS cannot reflect the full complexity of a human system that relies so heavily
on interpersonal communication. Furthermore, muc h of what contributes to system
success goes on outside the narrow confines of the IS artefact (i.e. the hardware,
software, processes and communications).
Thus in seeking to evaluate the effectiveness of a health IS we couldinadvertently or
explicitlyuse proxies for system success suchas patient outcomes, or make assumptions
about system use inwhat is essentially a human system; for example, assuming that all
relevantdata concerning patient encounters is actuallystored in the system.
We explore this complexity through the use of a framework which allows us to
compare key aspects of the human system with the type of problems portrayed in the
news media, and whether or not they constitute critical success factors. One of the
dependent variables most frequently suggested in the evaluation of such projects is
perceived usefulness DeLone and McLean (2003). If the system is perceived to be useful
this should be reflected in reports in the media, but it is subject to political influence.
Conversely the news media has a role to play in influencing perceived usefulness of
a system. The news media is a powerful mechanism through which public
understanding of the issues surrounding health information infrastr uctures are

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